Chronic fatigue syndrome: Features of a population of patients from northern Italy.

[A.B.]

In this study we analyzed the clinical features of a population of Italian patients with chronic fatigue syndrome (CFS) diagnosed according to the CDC-1994 criteria. The aim was to investigate CFS patients and their relatives, in order to search for events related to the onset of the disease and to identify correlations with other diseases. The analysis was carried out by examining medical records belonging to 82 patients suffering from the syndrome. The documentation was collected between 2008 and 2011 and provided by the non-profit Italian organization AMCFS (Associazione Malati di CFS). The influence of gender on the age of onset and association with potential risk factors were investigated in patients and in their relatives. From the results a significant correlation between the age of onset and autoimmunity was observed.

Free full text

Edit: updated with a link to the full paper.

 

[A.B.]

This has some discussion on autoimmunity:

Allergy and autoimmune diseases are the conditions mainly represented in families with CFS patients with 37 patients (45.7%) suffering from allergies and/or food intolerance and 12 patients (14.6%) with autoimmune diseases. Twenty-two percent of CFS patients have relatives with autoimmune diseases.

It can be observed that, among the PRFs considered, the only one that displayed a significant relationship with the age of onset was the presence of autoimmune diseases: patients with autoimmune diseases showed an average age of onset of approximately 40 ±3 years, while those without autoimmune diseases showed an average age of 30 ± 1.4 years (F1,80 = 6.979, P = 0.009)

PRF = potential risk factors.

CFS displays a fluctuating clinical course with periods of exacerbation and improvement similar to that of several autoimmune pathologies such as multiple sclerosis. Brenu and colleagues stated that CFS/ME may have a potential to be autoimmune because it shares certain parallels with a number of autoimmune diseases. The similarities include decreases in oxidative phosphorylation, reduced NK cytotoxic activity, defects in B cells, and equivocal levels of cytokines. Most autoimmune diseases demonstrate equivocal levels of immune cell numbers and/or alterations in their activation or functional capacity. The differences in cell numbers and phenotypes are related to the severity or the stage of the disease, therefore, patients in the latent phases may differ in the relative numbers of immune cells in comparison to those in the early and active stages of the disease. In CFS, a mechanism for disease presentation similar to that of known autoimmune diseases has not yet been established, so CFS may have an as yet unestablished autoimmune component or perhaps the symptoms of CFS are hallmarks of a novel autoimmune disorder yet to be identified

In our sample, patients with autoimmune diseases developed CFS at a later age than patients with CFS only. This observation suggests an influence of specific therapies for autoimmune disease and is indicative of an ongoing unidentified autoimmune reactivity in CFS patients, and is in agreement with many researchers who argue that CFS could be an autoimmune disease. The prevalence of women in the CFS population is another element in favor of the autoimmune hypothesis, since women carry a well-known high-risk factor for the majority of autoimmune diseases.

In conclusion, even if the CFS population analyzed is numerically not very consistent, recruited in only a few regions of northern Italy, and therefore cannot be considered representative of the entire population of Italian CFS patients, interesting elements have emerged that we feel are important for future surveys on the causes of this disease. In particular, the possibility that the disease is supported by an as yet unidentified autoimmune reactivity against antigens, suggests that we must concentrate our efforts in this direction.It is hoped, therefore, that further extensive research will be organized under the patronage of the health institutions, recruiting a sufficiently larger number of Italian population with the aim of identifying putative triggers for CFS and developing intervention strategies through the application of more targeted therapies. This would lead to considerable benefits for both patients and for a reduction in healthcare costs.

 

[Marky90]

Thanks A.B. Nice too see more researchers are following the autoimmunity thesis!